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NPI Code Detail

MEDICARE: MARICAROLYN RUCKER

MEDICARE: MARICAROLYN RUCKER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner141660MO

General Provider Information

NPI Number : 1467780304
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARICAROLYN RUCKER
Provider Business Mailing Address
First Line : 161 WASHINGTON ST
Second Line : EIGHT TOWER SUITE 1400
City : CONSHOHOCKEN
State : PA
Zip : 19428-2083
Country : US
Telephone Number : 866-825-3227
Fax Number :
Provider Business Practice Location Address
First Line : 6071 TELEGRAPH RD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63129-4758
Country : US
Telephone Number : 866-825-3227
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2009
Last Update Date : 12/04/2009

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Directions to “ MARICAROLYN RUCKER ” Practice Location

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